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NHS Services, Seven Days a Week: The “How” and the “Why” – Simon Bennett

Simon Bennett, NHS England’s Deputy Director Quality Framework Team, examines the issues surrounding 24/7 care: 

I want to focus on two things in this latest blog – the NHS Services, Seven Days a Week Forum as it prepares to publish its initial insight and evidence later in the autumn, and NHS England’s recent AGM.

The Forum is working through tricky issues about how to meet the reasonable expectations of patients and the public that NHS care and treatment they receive will be safe and of the same high quality, every day of the week. It’s a difficult challenge that, in some communities, will require transformational change to the way services are delivered in order for them to be clinically and financially sustainable.

At a special meeting of the Forum that took place on September 2, Forum members, external stakeholders and patient representatives were clear about the main challenges the NHS faces.

As part of the Forum’s review, a set of seven day clinical standards for commissioners have been defined. The challenge is to ensure the standards are ambitious enough to kick start change and innovation, while also being realistic. Vitally, they also need the support of commissioners and providers, as well as clinicians and patients.  Some of the required engagement has already taken place, and we plan a wider programme of engagement to explain these emerging standards after the Forum’s findings have been published.

Linked to this is the use of commissioning levers and enablers.  How can NHS England ensure that the appropriate national levers and incentives work to support delivery of the seven day clinical standards?

We also know that local solutions will be required. So how can we encourage commissioners and providers to rise to the challenge and identify new and innovative approaches to delivering services, in order to ensure every patient receives the care they need, seven days a week?

NHS Improving Quality (NHS IQ) is supporting the NHS Services, Seven Days a Week Forum and has recently invited local partnerships to come forward as ‘Early Adopters’ of seven day services, to take advantage of bespoke support and then share their learning. The closing date is October 14 and NHS IQ’s letter of invitation can be found here.

Consideration of the costs and benefits of widening access to NHS services is obviously a critical area for consideration by the Forum. They have benefited from a number of pilot studies undertaken by the Healthcare Financial Management Association. We know that some providers have already widened access to services, including at the weekend, but piecemeal implementation generally isn’t the most efficient use of scarce and expensive skills and resources. Where do we start the conversation about collaborating and networking in the interests of both safety and efficiency? And how can we move from funding services which are currently defined by ‘bricks and mortar’, to a system where the rewards reflect the extent to which the needs of patients are met?

Underpinning this whole discussion is the question of what the NHS will look like in the future. That’s why seven day services is a key issue for the Call to Action, which urges a collective approach to deliver fundamental changes to how we deliver and use health and care services.

I also want to also say something about the remarkable NHS England AGM that took place on September 12. While struggling with questions of “how”, it was a timely reminder of “why” seven day services matter.

Many of the clinicians and managers at the AGM gave us compelling clinical and organisational reasons for supporting a move to seven day services, but what really struck a chord were the stories from those who themselves had first-hand experience of the consequences of reduced service provision at the weekend.

A diverse group of patients, carers, members of the public and young people, as well as clinicians, delivered a clear message to NHS England’s Board – despite the challenges, high quality care seven days a week should not just be an ambition, it is essential.

A woman who had previously suffered a subarachnoid haemorrhage was terrified that if she became seriously ill at the weekend, she might not receive the urgent care that she needed. . .

A mother whose epileptic teenage daughter discharged herself at a weekend having been told she wouldn’t see a consultant until Monday.  She subsequently suffered an epileptic fit on a main road outside the hospital. . .

A nurse who described her own feeling of abandonment in a highly pressurised specialty, when she has no ready access to a consultant opinion at weekends. . .

Patients who spent a frustratingly long time on hospital wards, due to a lack of senior decision makers to progress their treatment…

A young woman whose emergency admission to a surgical ward during a weekend resulted in the loss of control of her diabetes and, when no specialist could be found, a dangerously delayed operation and a worse outcome. . .

The wife of a patient with a long term condition who was exasperated by the reduced level of information-sharing at the weekend and frightened of what might happen if one weekend she was unable to be at his side in the hospital, acting as his advocate …

A young mental health service user whose parents spent a weekend on “suicide watch” at home, after professionals begged her not to harm herself till services started up again on Monday. . .

Addressing the AGM attendees and the NHS England board, Professor Sir Bruce Keogh summed up the mood when he spoke of the challenge ahead “It’s going to be radical. It’s going to be difficult.  But we have to be up for it.”

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One comment

  1. Mary E Hoult says:

    With one in eight people using acute services registering a complaint how can things be improved?Patients are paying a high price for financial balance in Acute NHS Trusts,
    We keep reinventing the wheel in the hope all the bad press will disappear!!!!not so.,until we have proper informatics systems in place to support patients through their pathway of care the current system will continue. On trying to post these comments it looks like my contribution has been rejected out of hand so much for openness .